How to deal with wonky dental billing situation? (Deadline involved)
November 16, 2021 12:43 PM Subscribe
After months of silence after a billing issue was (supposedly) resolved, my dentist's office emailed me saying I have three days to pay a bill for $1xxx (after they blew off resubmitting a corrected claim to my provider). Options?
Long story I was having a dispute with my dentist's billing manager after I went in for gum surgery in April and was literally right after the surgery presented with a bill where my responsibiltiy was $XXXX more than what I was previously quoted. (Previously). After going back and forth with said manager, she finally agreed to resubmit their claim with correct coding (which is apparently what was causing the issues). I never heard back from her (no bills, etc) so I assumed it had been taken care of.
However, this morning I received an email and voicemail from her saying that I still owed $1XXX on my account and that I needed to pay it by this Friday or else it would go to a collection agency. (That's right, after months without any sending out any bills, voicemails, etc., they're giving me three days to pay them $1XXX or else). I checked with my dental provider, and they confirmed that they never received any corrected claims from the dentist's office.
Right now I plan to email her back to remind her of our earlier conversation where she said she would resubmit the corrected claims to my provider. However, has too much time passed (over six months) for them to resubmit their claim (and, if so, would I be on the hook for it despite their original estimate of my responsibility being far greater/lower than what they eventually billed me)? And is there a particular strategy that I should use here, especially if she claims ignorance of our previous conversation about her resubmitting the claims? (Depending on how the email exchange goes, I thought it might be good to tell her that it's not exactly kosher to go months without sending out a bill or a balance notice, and then expect to be paid within only three days).
Long story I was having a dispute with my dentist's billing manager after I went in for gum surgery in April and was literally right after the surgery presented with a bill where my responsibiltiy was $XXXX more than what I was previously quoted. (Previously). After going back and forth with said manager, she finally agreed to resubmit their claim with correct coding (which is apparently what was causing the issues). I never heard back from her (no bills, etc) so I assumed it had been taken care of.
However, this morning I received an email and voicemail from her saying that I still owed $1XXX on my account and that I needed to pay it by this Friday or else it would go to a collection agency. (That's right, after months without any sending out any bills, voicemails, etc., they're giving me three days to pay them $1XXX or else). I checked with my dental provider, and they confirmed that they never received any corrected claims from the dentist's office.
Right now I plan to email her back to remind her of our earlier conversation where she said she would resubmit the corrected claims to my provider. However, has too much time passed (over six months) for them to resubmit their claim (and, if so, would I be on the hook for it despite their original estimate of my responsibility being far greater/lower than what they eventually billed me)? And is there a particular strategy that I should use here, especially if she claims ignorance of our previous conversation about her resubmitting the claims? (Depending on how the email exchange goes, I thought it might be good to tell her that it's not exactly kosher to go months without sending out a bill or a balance notice, and then expect to be paid within only three days).
Best answer: I'm angry on your behalf. Yes, email her back with the details, but be prepared to escalate this quickly over her head - to the office manager or dentist. I would make it clear that you intend to pay them, but you don't feel that this has been settled properly. (They don't want to send it to collections, as they'll only get pennies on the dollar for the amount - use that to your advantage.)
See how she responds to your email, and escalate as needed. Write out all the facts as you know them so you can get someone else apprised of the situation.
Alternative: go in and kill her with kindness. "Oh, I'm so sorry about the balance due. I hadn't heard from you after you resubmitted the billing with the adjusted codes, so I thought we were all square. Did you get an update from my insurance? How much will they be covering? What date did you receive that information? I must have missed your notices... When did you send them?"
posted by hydra77 at 1:43 PM on November 16, 2021 [5 favorites]
See how she responds to your email, and escalate as needed. Write out all the facts as you know them so you can get someone else apprised of the situation.
Alternative: go in and kill her with kindness. "Oh, I'm so sorry about the balance due. I hadn't heard from you after you resubmitted the billing with the adjusted codes, so I thought we were all square. Did you get an update from my insurance? How much will they be covering? What date did you receive that information? I must have missed your notices... When did you send them?"
posted by hydra77 at 1:43 PM on November 16, 2021 [5 favorites]
Do you know what your insurance would have covered? Our dental insurance only covers 50%. If 1xxx is in the range of what might reasonably be your share (and depending on the procedure, that seems like it might be) then I would assume they have already made a concession in the billing amount and just pay it. (Yes, this is messed up and the lack of communication is annoying but if the amount bill is what you would probably owe than I would try not get hung up on that.) Then the next question is just what is the most reasonable way to pay it. Sending it to collections hurts them - they get only a percentage - so if you come back with a reasonable plan to pay it, they should accept it. Or i might just put it on a credit card to be done with it.
If the amount being charged is very much higher than your share after insurance, I would take the opposite approach. Send an email saying that she agreed to send a correct claim to insurance, your insurance shows no record of receiving it and they need to do their part first. If they do send it to collections, when you get contacted the first thing is to insist on only communicating in writing and the second thing is to ask for proof that you actually owe the money. Often you will never hear back at this point. Then dispute it based on you not owing that amount due to their failure to timely file a claim with insurance. If you are losing, then see what kind of a discount you can get for paying in full.
posted by metahawk at 1:45 PM on November 16, 2021 [1 favorite]
If the amount being charged is very much higher than your share after insurance, I would take the opposite approach. Send an email saying that she agreed to send a correct claim to insurance, your insurance shows no record of receiving it and they need to do their part first. If they do send it to collections, when you get contacted the first thing is to insist on only communicating in writing and the second thing is to ask for proof that you actually owe the money. Often you will never hear back at this point. Then dispute it based on you not owing that amount due to their failure to timely file a claim with insurance. If you are losing, then see what kind of a discount you can get for paying in full.
posted by metahawk at 1:45 PM on November 16, 2021 [1 favorite]
Left this reply on the wrong thread, sorry!
From prev posts you're in the US, right? What state are you in? If you're in CA you may be able to get free legal advice about this over the phone through your local Health Consumer Alliance provider. https://healthconsumer.org/
posted by peppercorn at 2:19 PM on November 16, 2021 [2 favorites]
From prev posts you're in the US, right? What state are you in? If you're in CA you may be able to get free legal advice about this over the phone through your local Health Consumer Alliance provider. https://healthconsumer.org/
posted by peppercorn at 2:19 PM on November 16, 2021 [2 favorites]
Response by poster: Yep, I'm in the US/CA. I'll check them out, thanks.
And I did already pay the $XXX that I originally owed, it's just the extra $1XXX that they're trying to stick me with that's the issue. (The dental provider said I could file a complaint with them if needed, would that be good to use as leverage?)
posted by gtrwolf at 2:30 PM on November 16, 2021
And I did already pay the $XXX that I originally owed, it's just the extra $1XXX that they're trying to stick me with that's the issue. (The dental provider said I could file a complaint with them if needed, would that be good to use as leverage?)
posted by gtrwolf at 2:30 PM on November 16, 2021
Are you going back to this dentist? Please find a new one and tell them their mistakes are the reason.
Pointing out the lack of bills feels like a good point, but the response might be "we sent one bill and that's all we send." Also, the complaint threat is also likely to be "no big deal" for them, so I would not start with that kind of threat. The point you want to start with is the fact that the bill is wrong and you need them to correct it. It would be worth asking your provider what the time frame is for you to submit for reimbursement and going that route if you feel you have the right documents.
You need to lay out the facts that you are waiting for the insurance company, and asking when they are going to resubmit the claim. If they say they won't, go up the chain. You need a resubmission before you are willing to pay anything and when will that happen? Until that happens, you disagree with the amount being charged. You will tell anyone else who calls collecting that the amount is wrong and you are waiting for a corrected invoice. If this how they run things, you won't be the only one.
posted by soelo at 6:25 PM on November 16, 2021 [1 favorite]
Pointing out the lack of bills feels like a good point, but the response might be "we sent one bill and that's all we send." Also, the complaint threat is also likely to be "no big deal" for them, so I would not start with that kind of threat. The point you want to start with is the fact that the bill is wrong and you need them to correct it. It would be worth asking your provider what the time frame is for you to submit for reimbursement and going that route if you feel you have the right documents.
You need to lay out the facts that you are waiting for the insurance company, and asking when they are going to resubmit the claim. If they say they won't, go up the chain. You need a resubmission before you are willing to pay anything and when will that happen? Until that happens, you disagree with the amount being charged. You will tell anyone else who calls collecting that the amount is wrong and you are waiting for a corrected invoice. If this how they run things, you won't be the only one.
posted by soelo at 6:25 PM on November 16, 2021 [1 favorite]
Have you ever received a valid bill for the amount in question? It seems that you immediately disputed the only copy you received, and they agreed it was wrong (or, at least, unsubstantiated - either way, invalid). It doesn't sound like they've even so much as given you a new copy of that bill and said 'no, we were right first time'. It's a struggle to demonstrate late payment if they have never successfully asked you to pay.
So if I were in your shoes I would start with 'What is this bill you want me to pay, exactly? Perhaps you'd like to send me a copy?' and explain to them in small detail how you'll require a copy of it along with the supporting evidence that the insurance claim has been taken into account - as previously agreed, no less.
posted by How much is that froggie in the window at 9:09 PM on November 16, 2021 [2 favorites]
So if I were in your shoes I would start with 'What is this bill you want me to pay, exactly? Perhaps you'd like to send me a copy?' and explain to them in small detail how you'll require a copy of it along with the supporting evidence that the insurance claim has been taken into account - as previously agreed, no less.
posted by How much is that froggie in the window at 9:09 PM on November 16, 2021 [2 favorites]
And I did already pay the $XXX that I originally owed, it's just the extra $1XXX that they're trying to stick me with that's the issue.
Sounds like they are trying to balance bill you, to recoup whatever amount your insurance and you did not cover from what they originally submitted to your insurer. Some insurers do not allow in-network providers to do this. You might want to discuss this with your insurer.
posted by Thorzdad at 6:36 AM on November 17, 2021 [1 favorite]
Sounds like they are trying to balance bill you, to recoup whatever amount your insurance and you did not cover from what they originally submitted to your insurer. Some insurers do not allow in-network providers to do this. You might want to discuss this with your insurer.
posted by Thorzdad at 6:36 AM on November 17, 2021 [1 favorite]
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posted by gtrwolf at 12:46 PM on November 16, 2021